Abstract

Eligibility criteriaMeta-analyses of randomised controlled trials with mortality outcomes
comparing the effectiveness of exercise and drug interventions with each
other or with control (placebo or usual care).

Data sourcesMedline and Cochrane Database of Systematic Reviews, May 2013.

ResultsWe included 16 (four exercise and 12 drug) meta-analyses. Incorporating
an additional three recent exercise trials, our review collectively
included 305 randomised controlled trials with 339 274 participants.
Across all four conditions with evidence on the effectiveness of
exercise on mortality outcomes (secondary prevention of coronary heart
disease, rehabilitation of stroke, treatment of heart failure,
prevention of diabetes), 14 716 participants were randomised to physical
activity interventions in 57 trials. No statistically detectable
differences were evident between exercise and drug interventions in the
secondary prevention of coronary heart disease and prediabetes. Physical
activity interventions were more effective than drug treatment among
patients with stroke (odds ratios, exercise v anticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11, 1.17 to 24.76). Inconsistency between direct and indirect comparisons was not significant.

ConclusionsAlthough limited in quantity, existing randomised trial evidence on
exercise interventions suggests that exercise and many drug
interventions are often potentially similar in terms of their mortality
benefits in the secondary prevention of coronary heart disease,
rehabilitation after stroke, treatment of heart failure, and prevention
of diabetes.